|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
OP
|
$1,132.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3913643001
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$534.16
|
| Rate for Payer: Aetna Government |
$534.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$373.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$373.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$373.91
|
| Rate for Payer: Brighton Health Commercial |
$849.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$534.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$905.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$769.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$534.16
|
| Rate for Payer: EmblemHealth Commercial |
$534.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$480.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$454.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$475.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$534.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$475.40
|
| Rate for Payer: Group Health Inc Commercial |
$534.16
|
| Rate for Payer: Group Health Inc Medicare |
$534.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$534.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$454.04
|
| Rate for Payer: Healthfirst QHP |
$534.16
|
| Rate for Payer: Humana Medicare |
$544.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$534.16
|
| Rate for Payer: United Healthcare Commercial |
$566.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$507.45
|
| Rate for Payer: Wellcare Medicare |
$507.45
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
IP
|
$1,132.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3613643001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$566.00 |
| Max. Negotiated Rate |
$566.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.00
|
|
|
HC BLOOD TRANSFUSION SERVICE
|
Facility
|
OP
|
$1,132.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
3613643001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$534.16
|
| Rate for Payer: Aetna Government |
$534.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$373.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$373.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$373.91
|
| Rate for Payer: Brighton Health Commercial |
$849.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$534.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$534.16
|
| Rate for Payer: EmblemHealth Commercial |
$534.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$480.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$454.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$475.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$534.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$475.40
|
| Rate for Payer: Group Health Inc Commercial |
$534.16
|
| Rate for Payer: Group Health Inc Medicare |
$534.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$534.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$454.04
|
| Rate for Payer: Healthfirst QHP |
$534.16
|
| Rate for Payer: Humana Medicare |
$544.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$534.16
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$534.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$507.45
|
| Rate for Payer: Wellcare Medicare |
$507.45
|
|
|
HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
3008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
3008690201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.35
|
| Rate for Payer: Aetna Government |
$6.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.45
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.35
|
| Rate for Payer: EmblemHealth Commercial |
$6.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.65
|
| Rate for Payer: Group Health Inc Commercial |
$6.35
|
| Rate for Payer: Group Health Inc Medicare |
$6.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.35
|
| Rate for Payer: Healthfirst QHP |
$6.35
|
| Rate for Payer: Humana Medicare |
$6.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.35
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.03
|
| Rate for Payer: Wellcare Medicare |
$5.71
|
|
|
HC BLOOD TYPING RBC ANTIGENS, A1 ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, A1 ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, C ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, C ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, E ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, E ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690502
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, FYA ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, FYA ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690504
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, FYB ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, FYB ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, JKA ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, JKA ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, JKB ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, JKB ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, K ANTIGEN TYPE
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690503
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, K ANTIGEN TYPE
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690503
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LEA ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LEA ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LEB ANTIGEN
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC BLOOD TYPING RBC ANTIGENS, LEB ANTIGEN
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 86905
|
| Hospital Charge Code |
3008690515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.83
|
| Rate for Payer: Aetna Government |
$3.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$3.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.41
|
| Rate for Payer: Group Health Inc Commercial |
$3.83
|
| Rate for Payer: Group Health Inc Medicare |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Healthfirst Essential Plan |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.83
|
| Rate for Payer: Healthfirst QHP |
$3.83
|
| Rate for Payer: Humana Medicare |
$3.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.83
|
| Rate for Payer: Wellcare Medicare |
$3.45
|
|
